Swallowing: ALT –vs- FJT
Yu P. Plast Reconstr Surg 2006
Hospital Course: ALT –vs- FJT
Yu P. Plast Reconstr Surg 2006
New Sensation
Implications of Sensory Innervation
Yu P. Head Neck 2004
Implications of Sensory Innervation
Superior sensory recovery in all testing
modalities
2 point discrimination
Monofilament testing
Pain
Temperature
Improves swallow function
Improves patient satisfaction
Post-op XRT may delay sensory recovery
Yu P. Head Neck 2004
Complications
ALT Failure Etiology
Inadvertent perforator division at fascial plane
Inadvertent perforator injury during
intramuscular dissection
Pedicle twisting during inset
Vessel size mismatch
Celik N. Plast Reconstr Surg 2002
ALT Failure Rates
Failure (%)
Sheih 2000 2.7
Demirkan 2000 3.3
Wei 2002 2.2
Makitie 2003 2.6
Donor-Site Morbidity
37 pts. with free or pedicled ALT
32 primary closure & 5 STSG closure
Results
Primary closure
All normal ADLs
87.5% appearance satisfaction
1 pt. with ↓ ROM
STSG
3/5 with ↓ ROM
Less appearance satisfaction
Sensation deficit in 87.5% of entire group
Kimata Y. Plast Reconstr Surg 2000
Donor-Site Morbidity:
ALT –vs- RF
37 pts. : 18 ALT, 19 RF
Telephone questionnaire
Results
Bothered by cold
RF: 26% -vs- ALT: 0%
Shape difference bothersome
RF: 32% -vs- ALT: 11%
Novak C. Microsurgery 2007
Complications
Necrosis of lower limb- case
report
Obstructed superficial
femoral artery by
angiography
Lateral circumflex femoral
artery supplied critical
collaterals
Importance of checking
popliteal pulsations
Absence necessitates
angiography
Hage J. Ann Plast Surg 2004
Post-Operative Complications
23 patients
Mureau M. Plast Reconstr Surg 2005
Objective Functional and Aesthetic
Follow-up: Recipient Site
14 patients Mureau M. Plast Reconstr Surg 2005
Objective Functional and Aesthetic
Follow-up: Donor Site
14 patients
Mureau M. Plast Reconstr Surg 2005
Post-Op Scar
Flap Smorgasbord
AVM
Pre-operative selective embolization
Resection & ALT reconstruction 6 months post-
embolization
Koshima I. Ann Plast Surg 2003
Buccal Mucosa Defects
Mouth opening and oral intake preserved
Chuang HC. Otolaryngol Head neck Surg 2007
Buccal Through-and-Through
Lower Lip
Yildirim S. Plast Reconstr Surg 2006
Pharyngoesophageal Reconstruction
Genden E. Arch Otolaryngol Head Neck Surg 2005
Lateral Skull Base Defects
Malata C. Ann Plast Surg 2006
Tongue and FOM
Agostini V. Brit J Plast Surg 2003
Anterior Skull Base
Scalp
Calikapan G. Microsurgery 2006
Scalp
Combined with Fibula Free Flap
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Anterolateral Thigh Free Flap Garrett Hauptman M.D. Faculty Advisor: Vicente A. Resto, M.D., Ph.D. The University of Texas Medical Branch Department of Otolaryngology
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